‘Oba­macare’ re­peal path wor­ries health care in­dus­try Stand-alone re­peal would cost bil­lions

Kuwait Times - - HEALTH & SCIENCE -

One by one, key health care in­dus­try groups are telling the in­com­ing Repub­li­can ad­min­is­tra­tion and Congress that it’s not a good idea to re­peal the 2010 health care law with­out clear plans to ad­dress the con­se­quences.

Hos­pi­tals, in­sur­ers and ac­tu­ar­ies - bean-coun­ters who make lon­grange eco­nomic es­ti­mates - have weighed in, and more in­ter­est groups are ex­pected to make their views known soon. Rep­re­sent­ing pa­tients, the Amer­i­can Can­cer So­ci­ety Can­cer Ac­tion Network re­minded law­mak­ers that lives are at stake.

The con­cerns go be­yond the ob­vi­ous po­ten­tial hard­ship for the 20 mil­lion peo­ple cov­ered by sub­si­dized pri­vate in­sur­ance and ex­panded Med­i­caid un­der Pres­i­dent Barack Obama’s sig­na­ture law.

Bil­lions in costs

Hos­pi­tals say a stand-alone re­peal would cost them bil­lions, com­pro­mis­ing their abil­ity to serve lo­cal com­mu­ni­ties. In­sur­ers say Congress must be care­ful not to cre­ate even more uncer­tainty and in­sta­bil­ity. Ac­tu­ar­ies worry the mere prom­ise of an even­tual re­place­ment won’t be enough to sus­tain the in­di­vid­ual health in­sur­ance mar­ket.

And the anti-can­cer network is con­cerned that pro­tec­tion for peo­ple with pre-ex­ist­ing health con­di­tions might be un­der­mined or lost. Be­fore the Af­ford­able Care Act, it was com­mon for in­sur­ers to deny cov­er­age to peo­ple with a can­cer di­ag­no­sis, even if suc­cess­fully treated, or to charge them more. Also, unin­sured peo­ple with can­cer are more likely to be di­ag­nosed late, when there’s less chance of a cure.

“Re­place­ment health care leg­is­la­tion that ac­com­pa­nies re­peal needs to pro­vide rec­og­nized pa­tient pro­tec­tions that cur­rently ex­ist,” Chris Hansen, the group’s pres­i­dent, said in a state­ment.

Repub­li­cans say they re­main res­o­lute in their de­ter­mi­na­tion to re­peal “Oba­macare,” but some also seem mind­ful of the po­ten­tial po­lit­i­cal risks.

The ba­sic plan un­der GOP con­sid­er­a­tion in­volves re­peal­ing the health law next year, but de­lay­ing the ef­fec­tive date to al­low Congress time to pass a re­place­ment. That re­place­ment pre­sum­ably would do many of the things the Af­ford­able Care Act does, such as sub­si­dize cov­er­age and pro­tect peo­ple in poor health, but with less reg­u­la­tion and with­out the un­pop­u­lar “in­di­vid­ual man­date” that forces most Amer­i­cans to have cov­er­age or risk fines. How­ever, re­place­ment leg­is­la­tion that cov­ers a com­pa­ra­ble num­ber of peo­ple would still re­quire bil­lions in gov­ern­ment fi­nanc­ing and ex­ten­sive reg­u­la­tions, a stum­bling block for the most con­ser­va­tive Repub­li­cans.

The path for­ward is com­pli­cated by the dy­nam­ics of the 2016 po­lit­i­cal cam­paign, which cen­tered on per­son­al­i­ties rather than pol­icy. Pres­i­dent-elect Don­ald Trump promised to re­peal “Oba­macare,” but his ideas for a re­place­ment plan were more talk­ing points than an ac­tual plan.

“Pub­lic opin­ion seems to be shift­ing,” said John Rother, pres­i­dent of the Na­tional Coali­tion on Health Care, an um­brella or­ga­ni­za­tion that in­cludes doc­tors, busi­nesses, unions, and re­li­gious groups. “It’s not clear when peo­ple say they want to ‘re­peal,’ what they mean by that. It may mean they just want to get rid of the in­di­vid­ual man­date.” Rother be­lieves the out­come ul­ti­mately hinges on a hand­ful of GOP se­na­tors.

“Mod­er­ate Repub­li­cans are wor­ried about the con­se­quences,” he said.

His coali­tion has writ­ten Congress to ex­press its con­cerns. In­dus­try groups are giv­ing law­mak­ers plenty to con­sider: The two main hospi­tal lob­bies - the Amer­i­can Hospi­tal Association and the Fed­er­a­tion of Amer­i­can Hos­pi­tals - re­leased stud­ies in­di­cat­ing more than $200 bil­lion in po­ten­tial losses for their mem­bers if the health law is re­pealed with­out restor­ing the fund­ing cuts that were used to fi­nance cov­er­age ex­pan­sion. “Losses of this mag­ni­tude can­not be sus­tained and will ... dec­i­mate hos­pi­tals’ and health sys­tems’ abil­ity to pro­vide ser­vices, weaken lo­cal economies ... and re­sult in mas­sive job losses,” the groups said in a let­ter to Trump.

Amer­ica’s Health In­sur­ance Plans, the big­gest in­surer lobby, said its mem­bers need time, as well as an as­sur­ance that fed­eral dol­lars will con­tinue to flow, in or­der to suc­cess­fully tran­si­tion to a new sys­tem un­der dif­fer­ent rules. It took the bet­ter part of three years once Obama’s health law was passed to launch its ma­jor cov­er­age ex­pan­sion, and that was any­thing but smooth. In­sur­ers said the new ad­min­is­tra­tion and Congress need to “send strong sig­nals” that they’re will­ing to main­tain the cur­rent mar­ket through at least Jan. 1, 2019.

Per­haps the most sober­ing as­sess­ment comes from a lit­tle­known group, the Amer­i­can Academy of Ac­tu­ar­ies, rep­re­sent­ing pro­fes­sion­als who as­sess the fi­nan­cial sta­bil­ity of pen­sion and health in­sur­ance pro­grams. Un­like hos­pi­tals and in­sur­ers, ac­tu­ar­ies don’t have a di­rect fi­nan­cial stake in the fu­ture of the health law. The group said de­lay­ing the ef­fec­tive date of a re­peal while a re­place­ment is worked out could cre­ate such uncer­tainty that it trig­gers a cri­sis for the in­di­vid­ual health in­sur­ance mar­ket.

That’s where peo­ple who don’t have job-based cov­er­age can buy poli­cies, in­clud­ing more than 10 mil­lion in HealthCare.gov and other gov­ern­ment mar­kets, and 9 mil­lion who pur­chase their plans in­de­pen­dently. “Sig­nif­i­cant mar­ket dis­rup­tion could re­sult, lead­ing to mil­lions of Amer­i­cans los­ing their health in­sur­ance,” the ac­tu­ar­ies’ group wrote Congress. —AP

WASH­ING­TON: In this March 23, 2010 file photo, Pres­i­dent Barack Obama signs the health care bill in the East Room of the White House. —AP

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